This comprehensive review examines the expanding role of surgery in managing infective endocarditis (IE), a severe cardiac complication with high mortality rates. The review highlights the increasing trend of surgical interventions, with over 50% of patients undergoing surgery in tertiary centers. Key preoperative considerations include accurate diagnosis, appropriate antimicrobial treatment, and timely surgery, especially for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favoring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also emphasizes the need for tailored surgical strategies for high-risk groups like intravenous drug users and the elderly. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, the review provides a detailed overview of current evidence in the surgical management of IE, emphasizing the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes.This comprehensive review examines the expanding role of surgery in managing infective endocarditis (IE), a severe cardiac complication with high mortality rates. The review highlights the increasing trend of surgical interventions, with over 50% of patients undergoing surgery in tertiary centers. Key preoperative considerations include accurate diagnosis, appropriate antimicrobial treatment, and timely surgery, especially for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favoring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also emphasizes the need for tailored surgical strategies for high-risk groups like intravenous drug users and the elderly. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, the review provides a detailed overview of current evidence in the surgical management of IE, emphasizing the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes.